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Applicant <br />Owner <br />1'+t° 808 <br />Little Canada, Minnesota PAID �o.w <br />APPLICATION FORM Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />Plan Review <br />€rY )' <br />(Name) <br />l�������� A� z C 2-7 7'7— ?CGS- <br />(Address) (Phone) <br />S Cc (v\ C. c�S <br />(Name) <br />Property Location (Street Address and Legal Description): <br />(Address) (Phone) <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />I� <br />S4c:rc (1 b c */, e S ; { b° e_ °L. yc; Q- itk aT t- <br />1-c-- <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ins and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />ii a application procedures and hereby agree to pay ail statements received from the City pertaining to additional applica- <br />tion expense. <br />Page 102 t) (Date) <br />WHITE — Office CANARY — Customer PINK —Pile Ca, <br />